3-Foot Standing AP versus 45° PA Radiograph for Osteoarthritis of the Knee

Dervin, Geoffrey F.; Feibel, Robert J.; Rody, Kelly; Grabowski, Jenny

doi:10.1097/00042752-200101000-00003

Cited by 24 publications

(30 citation statements)

References 18 publications

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“…[22][23][24][25][26] The increase in JSN score was clearly related to a JSW that was significantly smaller in the flexed LS view than in the standing AP view. Thus, the LS view, by illustrating the smallest JSW within the tibiofemoral compartment-that is, by more accurately imaging the site of maximum cartilage damage in the OA knee [22][23][24][25][26] -optimises the sensitivity of grading of JSN and, consequently, identification of early OA.…”

Section: Discussionmentioning

confidence: 91%

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Superiority of the Lyon schuss view over the standing anteroposterior view for detecting joint space narrowing, especially in the lateral tibiofemoral compartment, in early knee osteoarthritis

Merle-Vincent

Vignon

Brandt

et al. 2007

Annals of the Rheumatic Diseases

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Objective: To evaluate the validity of using the conventional anteroposterior (AP) radiograph of the knee in order to identify joint space narrowing (JSN) at an early stage of osteoarthritis (OA). Methods: Grading of JSN using a 0-5 score and quantitative measurement of joint space width (JSW) of the medial and lateral compartments of the tibiofemoral joint in AP and fluoroscopically assisted posteroanterior Lyon schuss (LS) radiographs of 202 patients with knee OA. Results: Knees without definite JSN (score ,2) were twice as common in AP than in LS radiographs (36.1% vs 18.8%). The number of knees showing definite medial JSN was identical in both views but four knees showing a medial OA in AP view were classified differently in the LS radiographs (three bicompartmental OA and one lateral OA). The frequency of lateral JSN was approximately twice as great in the LS view as in the AP view. JSN score was significantly higher (p,0.001) and JSW was significantly smaller (p,0.01) in the LS view than in the AP view. In knees with definite JSN, JSW of the compartment with no narrowing was significantly (p,0.04) larger than in knees that did not exhibit definite JSN. Medial JSW and lateral JSW were inversely correlated (p,0.001). Conclusions: The standing AP radiograph performed poorly in identifying both the location of JSN in patients with early tibiofemoral OA (especially, lateral OA) and the severity of JSN. The LS radiographs are preferable to standing AP views for the selection of patients for therapeutic trials of structure-modifying OA drugs.

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Section: Discussionmentioning

confidence: 91%

“…Radiographs of the knee in flexion have been shown to improve detection of tibiofemoral JSN. [22][23][24][25][26] However, the ability of such views to identify early medial or early lateral OA in the presence and absence of the other has not been investigated before.…”

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confidence: 99%

Superiority of the Lyon schuss view over the standing anteroposterior view for detecting joint space narrowing, especially in the lateral tibiofemoral compartment, in early knee osteoarthritis

Merle-Vincent

Vignon

Brandt

et al. 2007

Annals of the Rheumatic Diseases

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“…Previous studies have demonstrated the Rosenberg radiograph to more consistently predict osteoarthritis, given its ability to visualize the mid-flexion surface of the femoral condyles, which is a common site of degenerative wear 4,33 . However, these prior studies involved patient populations that were smaller and had more advanced osteoarthritis than the patient population in the current study.…”

Section: Discussionmentioning

confidence: 99%

Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation

Wright

Ross

Haas³

et al. 2014

The Journal of Bone and Joint Surgery

134

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The MARS Group* Background: Osteoarthritis of the knee is commonly diagnosed and monitored with radiography. However, the reliability of radiographic classification systems for osteoarthritis and the correlation of these classifications with the actual degree of confirmed degeneration of the articular cartilage of the tibiofemoral joint have not been adequately studied.Methods: As the Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) Group, we conducted a multicenter, prospective longitudinal cohort study of patients undergoing revision surgery after anterior cruciate ligament reconstruction. We followed 632 patients who underwent radiographic evaluation of the knee (an anteroposterior weight-bearing radiograph, a posteroanterior weight-bearing radiograph made with the knee in 45°of flexion [Rosenberg radiograph], or both) and arthroscopic evaluation of the articular surfaces. Three blinded examiners independently graded radiographic findings according to six commonly used systems-the Kellgren-Lawrence, International Knee Documentation Committee, Fairbank, Brandt et al., Ahlbäck, and Jäger-Wirth classifications. Interobserver reliability was assessed with use of the intraclass correlation coefficient. The association between radiographic classification and arthroscopic findings of tibiofemoral chondral disease was assessed with use of the Spearman correlation coefficient.Results: Overall, 45°posteroanterior flexion weight-bearing radiographs had higher interobserver reliability (intraclass correlation coefficient = 0.63; 95% confidence interval, 0.61 to 0.65) compared with anteroposterior radiographs (intraclass continued

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“…30 There are several reports in the literature, which have suggested the use of weight-bearing, flexed knee roentgenograms instead of extended knee. [31][32][33] However, a study reported that variations in knee positioning significantly influence the quantitative measurement of radiographic characteristics of OA. 34 A study conducted with normal knees, reported a difference of up to 2 mm between the flexed and extended knees and explained it with the changing contact area between femur and tibia.…”

Section: 12mentioning

confidence: 99%

Computer-assisted Joint Space Area Measurement: A New Technique in Patients With Knee Osteoarthritis

Ilhanli

Guder²,

Tosun

et al. 2017

Arch Rheumatol

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Objectives: This study aims to assess the validity and reproducibility of computer-assisted joint space area measurement in knee roentgenograms of patients with knee osteoarthritis and compare it with a qualitative method in knee roentgenograms and quantitative and semi-quantitative methods in magnetic resonance imaging. Patients and methods:The study included 40 knees of 40 patients diagnosed as osteoarthritis (14 males, 26 females; mean age 57.4±5.9 years; range 47 to 67 years). Only the patients who wrote consents for publication of their radiologic data, and with knee roentgenograms and magnetic resonance images of the same knees were selected. Computer-assisted measurements were applied to joint spaces by two blinded physicians, for two times with an interval of one week. Data were evaluated for intraobserver and interobserver consistency. Also, data were compared with qualitative (Kellgren-Lawrence classification), quantitative (joint space width, cartilage thickness, meniscal thickness in magnetic resonance images) and semi-quantitative methods (whole-organ magnetic resonance imaging score). Results: Intraobserver consistency was evaluated for each physician, which revealed no differences. Interobserver consistency was evaluated by comparing the measurements of two blinded physicians and no differences were found (p>0.05). There was no significant correlation between the grade of Kellgren-Lawrence classification and other variables; such as grade of meniscus, meniscal thickness, cartilage thickness and computerassisted joint space area measurements (p>0.05). While there was a positive correlation between computer-assisted joint space area measurement and other quantitative measurements, there was a negative correlation between computer-assisted joint space area measurement and whole-organ magnetic resonance imaging scores. Conclusion: When compared with qualitative, quantitative, and semi-quantitative methods, computer-assisted joint space area measurement seems to be a useful, reproducible, and cost-effective quantitative method for evaluating knee osteoarthritis.

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3-Foot Standing AP versus 45° PA Radiograph for Osteoarthritis of the Knee

Abstract: The bilateral 45 degrees PA is superior for detecting lateral compartment wear but offers no advantage on the medial side. This view should be considered as the screening radiograph of choice in evaluating osteoarthritis of the knee.

Cited by 24 publications

References 18 publications

Superiority of the Lyon schuss view over the standing anteroposterior view for detecting joint space narrowing, especially in the lateral tibiofemoral compartment, in early knee osteoarthritis

Superiority of the Lyon schuss view over the standing anteroposterior view for detecting joint space narrowing, especially in the lateral tibiofemoral compartment, in early knee osteoarthritis

Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation

Computer-assisted Joint Space Area Measurement: A New Technique in Patients With Knee Osteoarthritis

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